What is the role of chemotherapy when added to radiotherapy in the treatment of inoperable stage I NSCLC?
The addition of chemotherapy to radiotherapy in inoperable stage I NSCLC
Patients with stage I disease are usually operable, but surgery may not be possible due to comorbidity, poor lung function, tumour location or patient choice. In those patients the traditional treatment approach has comprised of radiotherapy alone, usually given over five or six weeks with curative intent. Studies have consistently demonstrated a survival benefit when chemotherapy is combined with such radiotherapy in inoperable NSCLC, but these studies were restricted to stage III non-small cell lung cancer. We do not have evidence that demonstrates the same benefit in inoperable stage I disease as this question has never been evaluated in a randomised clinical trial for this early stage of lung cancer.
Evidence summary and recommendations
Insufficient evidence exists to recommend routine use of chemotherapy along with radiation for the treatment of patients with inoperable stage I NSCLC.
- Rowell NP, Williams CJ. Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable). Cochrane Database Syst Rev 2001;(1):CD002935 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11279780.
- Curran WJ Jr, Paulus R, Langer CJ, Komaki R, Lee JS, Hauser S, et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst 2011 Oct 5;103(19):1452-60 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21903745.
- Furuse K, Fukuoka M, Kawahara M, Nishikawa H, Takada Y, Kudoh S, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol 1999 Sep;17(9):2692-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10561343.